Preventing Type 2 Diabetes in West Virginia: Sustaining and Scaling the National Diabetes Prevention Program

Transcription

1 Preventing Type 2 Diabetes in West Virginia: Sustaining and Scaling the National Diabetes Prevention Program Gina Wood, MPH, RD, LD West Virginia Public Health Symposium November 21, 2013

2 Program Objectives Define the problem of diabetes and prediabetes Describe the diagnostic criteria for prediabetes Describe the evidence base for the prevention of Type 2 diabetes Describe state level efforts to increase access to and use of the National Diabetes Prevention Program Describe methods and results of a pilot prevention program among Bureau for Public Health employees

3 Why Should We Care About Prediabetes? WE FIRST NEED TO UNDERSTAND THE BIG PICTURE

4 Diabetes/Prediabetes Diagnostic Criteria Normal PreDiabetes Diabetes Fasting mg/dl mg/dl 126 mg/dl or more Impaired Fasting Glucose OGTT 2 hours post glucose challenge ** 140 mg/dl or less mg/dl 200 mg/dl or more Impaired Glucose Tolerance A1C < 5.7% % 6.5%

5 What is Fueling the Epidemic of Type 2 Diabetes? Approximately 80% 90% of people with type 2 diabetes are overweight or obese In the United States, approximately 69% of adults are considered overweight or obese Obesity is the primary risk factor for developing Type 2 diabetes.

6 The Burden of Diabetes in the U.S. Boyle et al Population Health Metrics 8:29 CDC National Diabetes Fact Sheet 2011 CDC. Awareness of Prediabetes. MMWR 62(11);

7 The Diabetes Belt Lawrence E. Barker, PhD, Karen A. Kirtland, PhD, Edward W. Gregg, PhD, Linda S. Geiss, MA, and Theodore J. Thompson, MS. Geographic distribution of diagnosed diabetes in the United States: a diabetes b. American Journal of Preventive Medicine 2011;40(4).

8 The Burden of Diabetes in WV 240,626 with diabetes (12%) 465,900 with prediabetes (96,377 adults indicate having been told) WV Health Statistics Center (2011). Behavioral Risk Factor Surveillance System Institute for Alternative Futures, Diabetes 2025 Forecasting Model (2010)

9 Economic Impact of Diabetes Annual cost of diabetes in US is an estimated $245 billion (2012) Direct and indirect medical costs, disability, lost work, and premature death Care for people with diagnosed diabetes accounts for more than 1 in 5 health care dollars in the U.S Annual 2009 Cost of Care General Population, No Diabetes $4,400 All Persons with Diabetes (average) $11,700 Persons with Diabetes only $7,800 Persons with Diabetes and Complications $20,700 ADA Economic Costs of Diabetes in the U.S. in Diabetes Care 36:

10 Risk Increases with Age Percentage of Adults with Diagnosed Diabetes years 75+ years years years CDC, National Diabetes Surveillance System, Retrieved 4/18/2013

11 Other Risk Factors Family history History of GDM Prediabetes Being overweight/obese Low levels of physical activity Adults with hypertension and other cardiovascular risk factors

12 Type 2 Diabetes is Largely Preventable DIABETES PREVENTION RESEARCH

13 Major Diabetes Prevention Studies Finland, China, U.S., India and Japan All randomized controlled trials Long term outcomes with lifestyle intervention: Finnish Diabetes Prevention Study: 43% reduction 3 years post Da Qing Study: 43% reduction 14 years post Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

14 Diabetes Prevention Program Large RCT Conducted over 3 years Research Study Led by the National Institutes of Health 27 clinical centers Over 3200 participants overweight prediabetes 45% from minority groups Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

15 Diabetes Prevention Research Trial 158,777 screened OGTT 3819 randomized Lifestyle (1079) Metformin (1073) Placebo (1082) Thiazolidinedione (585) Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

16 Results Were Striking Lifestyle (1079) Metformin (1073) Placebo (1082) Thiazolidinedione (585) 5% weight reduction 3% weight reduction D/C 58% risk reduction 31% risk reduction Diabetes Rate 11%/year 24% risk reduction Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346: , 2002 Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

17 Diabetes Prevention Program Outcomes Study Original DPP: Type 2 diabetes risk reduction at 10 yrs Lifestyle Intervention vs. Placebo Original DPP Follow Up DPP after 10 Years 58% 34% Metformin vs. Placebo 31% 18% Diabetes Prevention Program Research Group. The Lancet 2009; 374:

18 The Diabetes Prevention Program in Practice TRANSLATING THE RESEARCH

19 Translating the DPP to Groups in Community Settings Similar levels of weight loss have been obtained in community based programs that deliver curriculum in a group setting: Deploy Research Study Montana Diabetes Prevention Program I CAN Prevent Diabetes Sites in Minnesota YMCA led classes with DPCA Lancet, : Amer J Prev Med (4): Diabetes Educator, : Amer J Prev Med (4):S301 S306 On the Cutting Edge (4): Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

20 HELP PD Results Largest translation of the DPP Demonstrated ROI of $2,227 over two years vs. the cost of usual care Reduced costs associated with: Hospitalizations ER Visits Outpatient procedures Prescriptions Cost of a Group Translation of the Diabetes Prevention Program. Am J Prev Med, Vol 44, Is 4, Supp 4; S381 S389, April Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

21 The National DPP Authorized by the ACA CDC Recognition Program Organizations who show capacity May be: Non profits and CBOs Corporations & businesses (worksites) Faith based organizations Health care facilities Fitness & wellness centers Educational institutions Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

22 Curriculum and Structure 22 session intensive lifestyle change program Delivered over months Community and organizational levels Group setting (10 16 participants) Facilitated by trained lifestyle coach(es) Based on principles of healthy eating, physical activity and behavior modification Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

23 The Diabetes Prevention Program in West Virginia STATE LEVEL EFFORTS BPH EMPLOYEE PROGRAM

24 Trained Coaches Division of HP&CD trained 65 coaches 12/12 WV has 72 trained coaches in total (15 20 active) Survey 9/13: 65% response rate 76% are permitted to facilitate as part of their current job 45% would consider contract/consultant work Primary barriers are lack of: Time Referrals Funding for materials Funding for marketing Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

25 Raising Awareness Among Health Care Providers Presentations at conferences, meetings and individual health centers Presentation to FQHC CEO s (WVPCA) WVPCA Clinical Quality Leadership Team Webinar for primary care center staff (WVPCA) Utilization of EMR data to identify at risk patients (WVU OHSR) published article in Perspectives in Health Information Management (Fall, 2013). Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

26 Developing and Implementing Systems of Referral Established service agreement with 3 pilot partnerships Provided assistance with developing processes that are integrated into their current delivery system Encouraged the development of feedback mechanisms to communicate with referring provider Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

27 Increasing Referrals Some health centers referring: Ritchie Regional Health Center New River Health Association Belington Clinic Ebenezer Medical Outreach Some are recognized to offer the program: Shenandoah Valley Medical System Cabin Creek Health Systems Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

28 PCMH (2011) and Meaningful Use 2 Criteria for PCMH and Meaningful Use Document Self management abilities for patients/families Use EMR to identify patient specific education resources and provide to more than 10% of patients Provide self management tools (for patient to record self care results) to patients/families Increasing Implementation in West Virginia Develop and document self management goals in collaboration with patients STATE LEVEL ACTIVITIES Provide Educational Resources or assist in Self Management CDC RECOGNIZED ORGANIZATIONS Counsel patients/families to adopt healthy behaviors Maintain STATE current resource EMPLOYEE list on five topics PILOT or key community services areas of importance to practice s population Offer opportunities for health education and peer support Track referrals provided to patients National DPP

29 Partner with Agencies to Recommend that Program be Offered as a Covered Health Benefit for Public Employees Met with Office of the Insurance Commissioner Met with a variety of insurers MOU with PEIA and WVU Extension Service Pilot program with state employees Approval of BPH Commissioner Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

30 Media Campaign Partnership with Change the Future WV Launching in early December Running until March Radio, TV, Print, Outdoor Boards, On line Targeted toward: 45+, overweight, sedentary women with history of GDM Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

31 CDC Recognized Organizations in WV Belington Wellness Center Berkeley County Health Department Brooke County Health Department Cabell Huntington Health Department Cabin Creek Health Systems Chertow Diabetes Center at Marshall University Diabetes Learning Center of Mon General Hospital Hancock County Senior Services Kanawha Charleston Health Department Mid Ohio Valley Health Department Potomac Valley Hospital Shenandoah Valley Medical System, Inc. Viridian Health Management West Virginia Bureau of Senior Services West Virginia University Extension Service Hancock County Health Department Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

32 Hancock Brooke Ohio Marshall 2 Diabetes Prevention Programs in West Virginia (40 as of 10/30/13) Wayne Cabell 2 Mingo Mason Lincoln Putnam Logan Jackson 1 Boone Wood 10 Kanawha 5 Wyoming 2 Clay Fayette 1 Gilmer Braxton Harrison 1 Lewis Greenbrier 2 Barbour 1 Mercer McDowell Wirt 3 Roane 4 Raleigh Ritchie 1 Cal- Houn 1 Tyler Nicholas Morgan Berkeley Mineral 1 Jefferson Hampshire Grant Pleasants Summers Wetzel Monroe Monongalia 3 Marion Preston Webster Upshur Taylor Pocahontas Randolph Tucker Pendleton Doddridge Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax Hardy

33 Diabetes Prevention Program Locations Barbour Belington: Belington Wellness Center Berkeley Martinsburg: Berkeley County Health Department Cabell Huntington: HIMG Huntington: Ebenezer Medical Outreach Calhoun Minnora: West Fork Senior Center Nutrition Site Fayette Fayetteville; United Methodist Church Greenbrier Rainelle: Rainelle Medical Center Lewisburg: Greenbrier County Health Dept. Hancock New Cumberland: Hancock County Senior Services (2 programs) Harrison Clarksburg: United Hospital Center Jackson Ripley: Hardman s Hardware Kanawha Clendenin: Clendenin Health Center Charleston: Kanawha Valley Senior Services Elkview: Elkview Community Center South Charleston: SC Recreation Center Charleston Arbors Monongalia Morgantown: Mon General Hospital (3 programs) Pleasants St. Mary s: Pleasants County Senior Center (2 programs) Ritchie Harrisville: Ritchie Regional Health Center Roane Amma: Amma Senior Center Spencer: Westbrook Health Services Spencer: Hardman s Hardware Spencer: Curves Wirt Elizabeth: Elizabeth United Methodist Church Elizabeth: Wirt County WIC Office Elizabeth: WVU Extension Service Office Wood Mineral Wells Coldwater Creek (4 programs) Parkersburg: Mid Ohio Valley Health Department Parkersburg: YMCA Parkersburg: Westbrook Health Services Parkersburg: Library Vienna: Pleasantview Towers Vienna: Elder Beerman Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

34 BPH Employee Program METHODS AND RESULTS

35 Methods 16 month timeframe Permission from BPH Commissioner 2 day training (University of Pittsburgh) Information sessions Risk Screening Enrollment Curriculum delivery (September, 2012 May, 2013)

36 Methods 22 sessions Didactic and interactive learning Nutrition, physical activity, behavior modification Make up sessions Data body weight, physical activity Weekly records (food intake and physical activity) Participant survey

37 Results 92% completion Mean attendance: 18.4 sessions 92% lost weight Mean weight loss = 5.6% 54% (7) achieved at least 5% weight loss 39% (5) exceeded 7% weight loss goal 23% (3) achieved physical activity goal Attendance = results

38 Survey Results Participation during the workday Increased self reported productivity, morale and satisfaction with employer Increased ability to live a healthy lifestyle 100% positive recommendation Health insurance reimbursement/premium reduction

39 Discussion Identification, recruitment and retention is possible Need additional support/resources for physical activity Bringing the program to the worksite and allowing employees time to participate during the work day is vital

40 Recommendations Buy in and support from leadership Offer the program at no cost (financial or time) Work with a TPA Systematic identification of those at risk Prospective (screening) Retrospective (data mining) Comprehensive marketing campaign/strategy

41 Conclusion Implementation of diabetes prevention programs in state government and other worksites may result in significant reductions in Type 2 diabetes and considerable cost savings to employers, insurers and the health care system

42 In Summary Public health efforts must turn to primary prevention focusing on those at highest risk West Virginia is well positioned to scale The National Diabetes Prevention Program Providers should identify those at risk and refer to available programs Buy in and support from top leadership to bring the program to state employees Buy in and support from employers and insurers to ensure sustainability Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

43 Resources CDC Prediabetes Risk Screening Tool: CDC s Diabetes Prevention Website National Diabetes Education Program (NDEP) Medicare Part B Coverage of Diabetes Screening screenings.html Centers for Disease Control American Diabetes Association basics/prevention/ Division of Health Promotion and Chronic Disease 350 Capitol Street, Room 514 Charleston, WV Fax

44 Contact Information Gina Wood, MPH, RD, LD Division of Health Promotion and Chronic Disease Bureau for Public Health